Senate GOP leaders on Thursday finally released their secret health-care reform bill, which would repeal Obamacare taxes, restructure subsidies to insurance customers, and both phase out Medicaid's expansion program and cap Medicaid spending.
Republicans plan to bring the controversial bill that was drafted in secret to a quick vote next week, but face potentially fatal opposition to it from several members of their own caucus.
The 142-page bill, if passed into law, would sharply reduce financial aid that currently helps millions of people obtain health coverage, while at the same time offering a tax break to primarily wealthy Americans to the tune of hundreds of billions of dollars. And it would loosen rules in a way that could lead to states allowing insurers to offer less-generous health plans.
The bill would repeal, retroactive to the beginning of 2016, the Obamacare rule requiring most Americans to have some form of health coverage or pay a tax penalty fine. That repeal is expected to sharply increase the number of people who don't have insurance, which could in turn lead insurers to raise premiums.
And it would repeal, retroactively to the beginning of 2016, the "employer mandate," which requires large employers to offer health insurance to workers or be fined.
The bill also would continue for at least two years to offer reimbursements to health insurance companies for subsidies that reduce out-of-pocket costs for low income customers of Obamacare plans. But those subsidies would end in 2020, which would increase deductibles and other out-of-pocket health expenses for millions of customers.
The federal government's share of funding for Medicaid, which is jointly run with individual states, would fall over the course of seven years to end up at around 57 percent of the cost of that program, which offers health coverage to the poor.
Under Obamacare, the federal government had guaranteed that its funding for adults newly eligible for Medicaid because of the Affordable Care Act would fall to no lower than 90 percent of their costs. That expansion program would begin being phased out in 2021, and fully repealed by three years later.
In another cost-cutting move, the bill would lower the maximum income level a household could have to still qualify for federal subsidies that help reduce the premiums people pay for enrollment for individual health plans. Obamacare currently bars subsidies to families that earn more than 400 percent of the federal poverty level. The new bill would reduce that cap to 350 percent of the poverty level.
Younger people, as a group, would end up paying less of a share of their income toward their individual health plans under the bill in comparison to what they pay now under Obamacare, while older people as a group would end up paying a larger share of their income.
Health plans that offer abortion services would not be eligible for the subsidies, according to the draft released Thursday.
The federal government also would end up spending less money subsidizing people's insurance purchases by changing how the value of those subsidies are calculated. The bill would use a less-expensive type of individual health plan to calculate those subsidies, as opposed to the pricier plan used under Obamacare.
The bill also seeks to repeal, to the start of 2017, the 3.8 percent tax on net investment income.
The Trump administration is expected to back the bill, which most GOP senators were learning the details of during a meeting Thursday morning. The bill is named the "Better Care Reconciliation Act of 2017."
"It's going to be very good," President Donald Trump said about an hour after the bill's release. "A little negotiation, but it's going to be very good." Trump did not elaborate.
The House's version of the bill, dubbed the American Health Care Act, is broadly unpopular among the public, and had been reportedly called "mean, mean, mean," by Trump during a meeting with senators. Weeks earlier, Trump and House members who voted for the ACHA celebrated its passage in the Rose Garden of the White House.
A new NBC News/Wall Street Journal Poll released Thursday found that just 16 percent of Americans thought the House bill was a good idea, with 48 percent saying it is a bad idea.
"In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal heath spending, big increase in the uninsured," tweeted Larry Levitt, an Obamacare expert at the Kaiser Family Foundation.
"Under the Senate bill, low-income people would pay higher premiums for bigger deductibles," Levitt said.
He had noted on Twitter on Wednesday that "A 60 year-old at 351% of poverty currently gets a premium subsidy of $5,151 per year on average." The Senate bill would eliminate all of that federal financial aid if it becomes law.
Senate GOP leaders want to have a vote on the bill by late next week, before Congress' Fourth of July recess. They do not plan to hold any hearings on the legislation, infuriating Democrats, who were frozen out of the drafting process.
To pass, Republicans must get at least 50 GOP senators to vote for the bill, since no Democrat or independent is expected to vote for it. Vice President Mike Pence would break any tie, and would be expected to vote for the bill. There are 52 Republican senators.
On Thursday, about an hour after the bill was posted online, NBC's Chuck Todd tweeted that a group of a conservative Republican senators were meeting, and that there are at least three GOP senators, and possibly more, who plan to announce later today that they will oppose the bill.
If that number proves to be accurate, it could be a death blow to the bill.
Sen. Rand Paul, R-Ky., told NBC that he and several other members of the GOP caucus would be making a statement on the bill later Thursday.
"It looks like we're keeping Obamacare, not repealing it," said Paul, who declined to say whether that meant he would vote against the bill.
